<!DOCTYPE html>
<html lang="zh">
<head th:replace="~{frag::head}"></head>
  
<body>
<div class="lyear-layout-web">
  <div class="lyear-layout-container">
    <!--左侧导航-->
	<aside th:replace="~{frag::sidebar}"></aside>
    <!--End 左侧导航-->
    
    <!--头部信息-->
    <header th:replace="~{frag::header}"></header>
    <!--End 头部信息-->
    
    <!--页面主要内容-->
    <main class="lyear-layout-content">
      
      <div class="container-fluid">

        <div class="row">
          
          <div class="col-lg-12">
            <div class="card">
              <div class="card-header">
                <h4>添加新医疗机构信息</h4>
                </div>
                  <div class="card-body">
                      <form class="form-horizontal" action="/medicalInstitution/add" method="post">
			<div class="form-group">
			    <label class="col-md-2 control-label" for="diaId">医疗机构编号</label>
			  <div class="col-md-4">
			    <input class="form-control" type="text" id="diaId" name="diaId" placeholder="请输入医疗机构编号..">
			  </div>
			    <label class="col-md-2 control-label" for="diaName">医疗机构名称</label>
			  <div class="col-md-4">
			    <input class="form-control" type="text" id="diaName" name="diaName" placeholder="请输入医疗机构名称..">
			  </div>
			</div>
			
			<div class="form-group">
			    <label class="col-md-2 control-label" for="diaStarttime">开始日期</label>
			  <div class="col-md-4">
			    <input class="form-control js-datepicker m-b-10" type="text" id="diaStarttime" name="diaStarttime"
                 placeholder="yyyy-mm-dd" value="" data-date-format="yyyy-mm-dd" />
			  </div>
			    <label class="col-md-2 control-label" for="diaEndtime">结束日期</label>
			  <div class="col-md-4">
			    <input class="form-control js-datepicker m-b-10" type="text" id="diaEndtime" name="diaEndtime"
                 placeholder="yyyy-mm-dd" value="" data-date-format="yyyy-mm-dd" />
              </div>
			</div>
			
			<div class="form-group">
			    <label class="col-md-2 control-label" for="diaExpType">收费类别</label>
                  <div class="col-md-4">
                      <select class="form-control" id="diaExpType" name="diaExpType" size="1">
                          <option value="">请选择收费类别</option>
                          <option value="0">西药</option>
                          <option value="1">中成药</option>
                          <option value="2">中草药</option>
                          <option value="3">床位费</option>
                          <option value="4">化验费</option>
                          <option value="5">诊查费</option>
                          <option value="6">检查费</option>
                          <option value="7">护理费</option>
                          <option value="8">特检费</option>
                          <option value="9">输氧费</option>
                          <option value="10">治疗费</option>
                          <option value="11">输血费</option>
                          <option value="12">特治费</option>
                          <option value="13">医疗服务费</option>
                          <option value="14">手术费</option>
                          <option value="15">麻药费</option>
                          <option value="16">产前检查费</option>
                          <option value="17">材料费</option>
                          <option value="18">新生儿费</option>
                          <option value="19">内置材料</option>
                          <option value="20">其他费</option>
                          <option value="21">监护床位费</option>
                          <option value="22">非处方药</option>
                          <option value="23">处方药</option>
                          <option value="24">甲类</option>
                          <option value="25">乙类</option>
                          <option value="26">丙类</option>
                          <option value="27">化验费</option>
                          <option value="28">诊查费</option>
                          <option value="29">检查费</option>
                          <option value="30">护理费</option>
                          <option value="31">特检费</option>
                          <option value="32">输氧费</option>
                          <option value="33">治疗费</option>
                          <option value="34">输血费</option>
                          <option value="35">特治费</option>
                          <option value="36">医疗服务费</option>
                          <option value="37">手术费</option>
                          <option value="38">麻药费</option>
                          <option value="39">产前检查费</option>
                          <option value="40">材料费</option>
                          <option value="41">新生儿费</option>
                          <option value="42">内置材料</option>
                          <option value="43">其他费</option>
                          <option value="44">监护床位费</option>
                      </select>
                  </div>
                    <label class="col-md-2 control-label" for="diaValid">有效标志</label>
                  <div class="col-md-4">
                      <select class="form-control" id="diaValid" name="diaValid" size="1">
				  <option value="">请选择有效标志</option>
                          <option value="0">无效</option>
                          <option value="1">有效</option>
                      </select>
                  </div>
                </div>

			<div class="form-group">

			      <label class="col-md-2 control-label" for="diaExpLevel">收费项目等级</label>
			    <div class="col-md-4">
			    	<select class="form-control" id="diaExpLevel" name="diaExpLevel" size="1">
			          <option value="">请选择收费项目等级</option>
			          <option value="0">甲类</option>
			          <option value="1">乙类</option>
			          <option value="2">丙类</option>
			        </select>
				</div>

				  <label class="col-md-2 control-label" for="diaHosLevel">医院等级</label>
				<div class="col-md-4">
				    <select class="form-control" id="diaHosLevel" name="diaHosLevel" size="1">
				  <option value="">请选择医院等级</option>
				      <option value="0">一级医院</option>
				      <option value="1">二级医院</option>
				      <option value="2">三级医院</option>
				      <option value="3">社区医院</option>
				      <option value="4">所有医院</option>
				    </select>                          
				</div>
			</div>
			
			<div class="form-group">

				  <label class="col-md-2 control-label" for="diaMaxPrice">最高限价</label>
                    <div class="col-md-10">
			    	<input class="form-control" type="text" id="diaMaxPrice" name="diaMaxPrice" placeholder="请输入最高限价..">
				</div>
			  
                    <div class="form-group">
                      <div class="col-md-11 col-md-offset-1">
                        <button class="btn btn-primary" type="submit">添加</button>
                      </div>
                    </div>
                    </div>
                  </form>
              </div>
          </div>
        </div>
      </div>

    </main>
      </div>

    <!--End 页面主要内容-->
  </div>
</div>

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